Your dog as emotional support: what's actually true, including during serious illness and end of life

Around the dog as “emotional support” hangs a cloud of terms that blur together: assistance dog, therapy dog, emotional support animal. That’s more than a matter of wording. It determines whether a dog can go everywhere with you, and it also shapes the expectations of people who, during a difficult time, look to a dog for support. This article tries to bring some clarity to that, followed by an honest look at what research shows, what’s concretely possible in Belgium and the Netherlands around serious illness and end of life, and what a dog can’t be.

Assistance dog, therapy dog, or emotional support animal: the difference

An assistance dog (also called a service dog or guide dog) is trained by a recognised school to carry out specific tasks for one owner with a disability or illness. That recognition comes with a legal right of access: in Belgium since the implementing decrees of the 2009 Flemish decree, in force since 1 January 2014; in the Netherlands through the Equal Treatment on the Grounds of Disability or Chronic Illness Act (2016). A therapy dog is something different: it works alongside a trained handler during visits, for example to a care home, and has no legal right of access of its own outside that specific, supervised setting.

An emotional support animal (ESA), the concept that has its own legal status in the United States, doesn’t exist as a recognised category in Belgium or the Netherlands. There’s no law that defines or excludes the term, it simply isn’t present in the regulations around assistance dogs: no recognition means no enforceable right of access. That distinction isn’t just theoretical. Unia, Belgium’s equal opportunities centre, warned in 2026 of a growing number of unrecognised assistance dogs and dogs wrongly presented as “emotional support” to claim access they have no legal right to. Waiting times at recognised Belgian assistance dog schools can run up to four years, which Unia notes is itself a driver toward unrecognised providers, at the expense of trust in genuine assistance dogs. In the Netherlands, the Netherlands Institute for Human Rights confirms that recognised assistance dogs are still regularly refused entry despite their legal right, a sign that even the recognised category isn’t everywhere a given in practice.

What research shows about anxiety and loneliness

There’s a real and growing field of research into the effect of animals on anxiety, stress and loneliness in people with serious illness, but an honest caveat is needed: the quality of that evidence is still methodologically somewhat weak. A study among patients in the last phase of life (Scagnetto et al., 2020, Journal of Alternative and Complementary Medicine) measured anxiety before and after a short session with a therapy animal, and found a significant drop, but only in patients who had themselves owned a pet before. In people without that history, anxiety actually rose slightly, a nuance that tempers the “a dog always helps” picture.

A broader scoping review from 2024 (Palomino-Lázaro et al.) selected 16 studies on animal-assisted therapy in palliative care from more than 3,200 publications found. Conclusion: there are consistent indications of reduced anxiety, stress and loneliness, and sometimes better quality of life, with measurable physiological effects such as lower cortisol and heart rate. But the authors themselves clearly list the limitations: small samples, few controlled trials, a lot of subjective measures, and a publication bias where mostly positive results get published. The direction of the evidence is positive, then; its strength isn’t yet established.

A therapy dog visit: how it works in practice

Both the Netherlands and Belgium have organisations that, with trained volunteer-and-dog teams, visit elderly people, people with disabilities, or isolated residents of a care institution: in the Netherlands, among others, Stichting Kwispelhelden; in Belgium, T-Dogs vzw. In fairness: neither organisation presents itself specifically as a hospice or palliative care service. Hospice visits do occur within their broader institutional-visit offering, but we couldn’t identify a Belgian or Dutch therapy dog organisation that specialises exclusively in palliative care. Some Dutch hospices do confirm on their own websites that pet visits, including visiting therapy dogs, are simply possible in practice, though that policy is set per institution rather than nationally.

Your own dog at the hospital bedside

More concrete policy exists here than you might expect. Zuyderland Medisch Centrum in the Netherlands developed a protocol allowing patients in the last phase of life who can no longer go home or to a hospice to receive their own pet on the ward, with conditions around vaccination and hygiene, and a treating doctor who assesses whether it’s suitable for that particular patient. UZ Leuven in Belgium has a standing pet visiting room: patients admitted for at least seven days can meet their dog or cat there for an hour (full vaccination passport, no health complaints), provided it’s arranged at least five days in advance through nursing staff.

Outside these two concrete examples, this isn’t a national standard: many hospitals in both countries still have no established protocol for it. So always check directly with the department involved about what’s possible, rather than assuming it’s possible everywhere, or nowhere.

When it’s the dog itself that’s dying

Grief over a pet still often isn’t seen as “real” grief, something science has a name for: disenfranchised grief, grief the surrounding world doesn’t recognise or validate. A qualitative study among pet owners (Packman et al., 2014, OMEGA — Journal of Death and Dying) describes that recurring pattern: a lack of outside recognition, the intensity of the grief, and the way people keep continuing their bond with a pet that’s died, in their own way.

More and more vet practices in the Netherlands and Belgium now offer at-home euthanasia, in the dog’s familiar surroundings, with time deliberately set aside for the farewell. Practical advice that keeps recurring across sources: arrange administrative matters like cremation beforehand, so you don’t have to deal with them after the farewell itself. Both countries also have private grief counsellors who specialise in pet loss. It’s worth being honest here: this isn’t a recognised allied health profession with official accreditation or insurance coverage, more a young, emerging field of individual initiatives. That doesn’t make it any less valuable for those who benefit from it, but it is something different from regular mental health care.

What a dog can’t do, and shouldn’t replace

The same boundary comes up throughout the professional literature: animal-assisted interventions are complementary, never a substitute for psychotherapy, pain management, or palliative care from a doctor or chaplain. Even a recognised psychiatric service dog is only assigned to someone already under the care of a recognised mental health professional: the dog supports a treatment plan, it doesn’t replace one. That’s exactly why the methodological caution in the research above fits a realistic, measured expectation: a dog can make a real difference in how someone feels, without replacing the care that person needs.

In short

An assistance dog has a legal right of access, a therapy dog works in a supervised, specific context, and an emotional support animal has no legal status of its own in Belgium or the Netherlands. Research points to a real, though not yet firmly established, effect of animals on anxiety and loneliness during serious illness. At a limited number of hospitals, such as Zuyderland and UZ Leuven, your own dog can even visit you at the very end of life, under certain conditions. And when it’s the dog itself that’s lost, the grief that follows is a recognised, if still underexposed, topic, with a cautiously growing private support offering. None of it replaces professional care, but none of it denies what a dog can mean to someone either.

Frequently asked questions

Is an emotional support dog the same as an assistance dog? No. An assistance dog is trained by a recognised school and therefore has a legal right of access to public places. An emotional support animal has no legal status of its own in Belgium or the Netherlands, unlike in the United States.

Can I bring my own dog to the hospital at the end of life? Some hospitals make this possible under conditions, such as Zuyderland Medisch Centrum in the Netherlands and the pet visiting room at UZ Leuven in Belgium. This isn’t a national standard: always check with the department involved.

Does professional help exist for the loss of a pet? There are private grief counsellors who specialise in this, but it isn’t a recognised allied health profession with official accreditation or insurance coverage. Grief over a pet is, however, recognised in the scientific literature as an often underestimated form of loss.